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Home My WebLink AboutFMC 2011Pzss MONITORING SYSTEM CERTIFICATION For Use ByAl/ Juilsdictions Within the State ofCalifornia Authority Cited: Chapter 6.7, Health and Safety Code; Chapter 16, Division 3, Title 23, California Code ofRegulations This form must be used to document testing and servicing ofmonitoring equipment. A separate certification or report must be prepared for each monitoring system control panel by the technician who performs the work. A copy of this form trust be provided to the tank system owner /operator. The owner /operator must submit a copy of this form to the local agency regulating UST systems within 30 days oftest date. A. General Information Facility Name: Sprint Bakersfield Bldg. No.: Site Address: 715 E. summer City: _Bakersfield Zip: 93385 Facility Contact Person: Doye Make/Model of Monitoring System: Veeder -Root TLS 350 B. Inventory of Equipment Tested/Certified Checkthe appropriate boxes to Indicate specific eaulpment Inspected/serviced: Contact Phone No.: (_217 _)_663 -9440 Date of Testing/Servicing: _102-262-2011 Tank 11): Diesel 550 gal Tank ID: In -Tank Gauging Probe. Model: Mug I O In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: 794390- 409 O Annular Space or Vault Sensor. Model: IM Piping Sump / Trench Sensor(s). Model: 794380 -208 L] Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). _ Model: Fill Sump Sensor(s). _. Model: O Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: flapper/ VR ext Alarm Tank Overfill / High -Level Sensor. Model: Other (specify ui ment type and model in Section E on Page 2). Other (specifX equipment aand model in Section E on Page 2). Tank ID: TankID: In -Tank Gauging Probe. Model: O In -Tank Gauging Probe. Model: Annular Space or Vault Sensor. Model: Annular Space or Vault Sensor. Model: Piping Sump / Trench Sensor(s). Model: Piping Sump / Trench Sensor(s). Model: Fill Sump Sensor(s). Model: Fill Sump Sensor(s). Model: Mechanical Line Leak Detector. Model: Mechanical Line Leak Detector. Model: Electronic Line Leak Detector. Model: Electronic Line Leak Detector. Model: Tank Overfill / High -Level Sensor. Model: Tank Overfill / High -Level Sensor. Model: Cl Other (specify equipment a and model in Section E on Pa e 2 . O Other (specify ui mart a and model in Section E on Page 22. Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: O Dispenser Containment Sensor(s). Model: Shear Valve(s). Shear Valve(s). O Dispenser Containment Floats and Chain(s). DiTenser Containment Floats and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). O Shear Valve(s). Dispenser Containment Floats and Chain(s). Dispenser Containment Floats and Chain(s). Dispenser ID: Dispenser ID: Dispenser Containment Sensor(s). Model: Dispenser Containment Sensor(s). Model: Shear Valve(s). ShearValve(s). Dis enser Containment Floats and Chains . Dispenser Containment Floats and Chain(s). If the facility contains more tanks or dispensers, copy this form. Include information for every tank and dispenser at the facility. C. Certification -I certify that the equipment Identlfled in this document was Inspected/serviced in accordance with the manufacturers' guidelines. Attached to this Certification is information (e.g. manufacturers' checklists) necessary to verify that this Information is correct and a Plot Plan showing the layout of monitoring equipment. For any equipment capable of generating such reports, I have also attached a copy ofthe report; (check aft that app(i): ® System set -tip ® ri history report Technician Name (print): Peter Jauregui III Signature: 5— Certification No.: B34641 License, No.: 708231 Testing Company Name: _Jauregui &Culver inc Site Address: 959 W. Mission Ave Escondido CA 92025 Page 1 of 3 Monitoring System Certification Phone No.: (_760J_734 -0518 Date of Testing/Servicing: _10 / 26/2011 03/01 D. Results of Testing/Servicing Software Version Installed: 17.01 Complete the followine checklist: Yes No* Is the audible alarm operational? Yes No* Is the visual alarm operational? Yes No* Were all sensors visually inspected, functionally tested and confirmed operational? Yes No* Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not interfere with their proper operation? Yes No* If alarms are relayed to a remote monitoring station, is all communications equipment (e.g. modem) N/A operational? Yes No* For pressurized piping systems, does the turbine automatically shut down if the piping secondary containment IM N/A monitoring system detects a leak, fails to operate, or is electrically disconnected? If yes: which sensors initiate positive shut -down? (Check all that apply) Sump/Trench Sensors; Dispenser Containment Sensors. Did you confirmpositive shut -down due to leaks and sensor failure /disconnection? Yes; No. Yes No* For tank systems that utilize the monitoring system as the primary tank overfill warning device (i.e. no N/A mechanical overfill prevention valve is installed), is the overfill warning alarm visible and audible at the tank fill point (s) and operating properly? If so at what percent of tank capacity does the alarm trigger? 90 % Yes* No Was any monitoring equipment replaced? if yes, identify specific sensors, probes, or other equipment replaced and list the manufacturer name and model for all replacement parts in Section E, below. Yes* No Was liquid found inside any secondary containment systems designed as dry systems? (Check all that apply) Product; Water. Ifyes, describe causes in Section E, below. Yes No* Was monitoring system set-up reviewed to ensure proper settings? Attach set up reports, ifapplicable Yes I O No* Is all monitorin& equipment o erational per manufacturer's specifications? In Section E below, describe how and when these deficiencies were or will be corrected. E. Comments: Page 2 of 3 03/01 F. In -Tank Gauging / SIR Equipment: ® Check this box if tank gauging is used only for inventory control. Check this box ifno tank gauging or SIR equipment is installed. This section must be completed if in -tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: Yes No* Has all input wiring been inspected for proper entry and termination, including testing for ground faults? Yes No* Were all tank gauging probes visually inspected for damage and residue buildup? R]Yes No* Was accuracy ofsystem product level readings tested? Yes No* Was accuracy ofsystem water level readings tested? Yes No* Were all probes reinstalled properly? Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): Complete the following checklist: IT Check this box if LLDs are not installed. Yes No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performance? N/A Check all that apply) Simulated leak rate: 3 g.p.h.; 0.1 g.p.h ; 0.2 g.p.h. Yes No* Were all LLDs confirmed operational and accurate within regulatory requirements? Yes No* Was the testing apparatus properly calibrated? Yes No* For mechanical LLDs, does the LLD restrict product flow if it detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if the LLD detects a leak? N/A Yes No* For electronic LLDs, does the turbine automatically shut off if any portion ofthe monitoring system is disabled N/A or disconnected? Yes No* For electronic LLDs, does the turbine automatically shut off ifany portion ofthe monitoring system malfunctions N/A or fails a test? Yes No* For electronic LLDs, have all accessible wiring connections been visually inspected? N/A Yes No* Were all items on the equipment manufacturer's maintenance checklist completed? In the Section H, below, describe how and when these deficiencies were or will be corrected. H. Comments: Page 3 of 3 03 /01 UNDERGROUND STORAGE TANK MONITORING SYSTEM CERTIFICATION Permit Number: UST Monitoring Site Plan Site Address: 7I5 E. SUMNER City: BAKERSFIELD Zip: 93385- TLS 350 Generator Room Main Overfill Building Alarm Fill/Piping Sump Ow /tank probe Annular O DIESEL Fiberglass Tank 550 Gal I ......... I....... I ............... Date map was drawn: 2009 If you already have a diagram that shows all required information, you may include it, rather than this page, with your Monitoring System Certification. On your site plan, show the general layout of tanks and piping. Clearly identify locations of the following equipment, if installed: monitoring system control panels; sensors monitoring tank annular spaces, sumps, dispenser pans, spill containers, or other secondary containment areas; mechanical or electronic line leak detectors; and in- tank liquid level probes (ifused for leak detection). In the space provided, note the date this Site Plan was prepared, 4 SWRCB, January 2006 Spill Bucket Testing Report Form Thisform is intendedfor use by contractors peifonning annual testing ofUSTspill contaimnent structures. The completedform and printoutsfrom tests (ifapplicable), should be provided to thefacility otivner/opei•atoi•for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Sprint Bakersfield Date ofTesting: 10/19/2011 Facility Address: 715 E. Sumner, Bakersfield, Ca 93385 Facility Contact: Doye Phone: 217 - 663 -9440 Date Local Agency Was Notified of Testing Name ofLocal Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Jauregui & Culver inc Technician Conducting Test: Peter Jauregui III Credentials: x CSLB Contractor x ICC Service Tech. SWRCB Tank Tester 0 Other (Spec) License Number(s): 708231, 5315297 3. SPILL BUCKET TESTING INFORMATION Test Method Used: x Hydrostatic Vacuum Other Test Equipment Used: Water and Tape Measure Equipment Resolution: 0 Loss r.,.,., Identify Spill Bucket (By Tank Manber, Stored Product, etc. Diesel 2 3 4 Bucket Installation Type: Direct Bury X Contained in Sump Direct Bury 0 Contained in Sump Direct Bury Contained in Sump Direct Bury Contained in Sum Bucket Diameter: 12” Bucket Depth: 13" Wait time between applying vacuum/water and start oftest: 20 min Test Start Time (Tr): 8:40 Initial Reading (RD: 11 %:" Test End Time (TF): 9:40 Final Reading (RF): 11 h" Test Duration (TF — Tt): I hr Change in Reading (RF -R): 0 change Pass/Fail Threshold or Criteria: 0 loss Test Result:. X Pass Fail Pass Fail 0 Pass Fail O Pass 0 Fail Comments — (include information on repairs madeprior to testing, and reconunendedfolloiv -tipforfailed tests) Test water was deemed non hazardous and removed from site for future testinl7. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING l hereby certify that all the information contained in this report is true, accurate, and infull compliance with legal requirements. Technician's Date: 11 /26/2011 State laws and regulations do t 9 q rrrently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. SPRINT AUTO TRANSMIT SETTINGS: VOLUME 412 GALS 715 SUMNER STREET ULLAGE 136 GALS AUTO LEAK ALARM LIMIT BAKERSFIELD, CA DISABLED TO VOLUME = 408 GALS 661 -332 -8592 COMMUNICATIONS SETUP OCT 26, 2011 10:06 AM WATER VOL = 0 GALS AUTO OVERFILL LIMIT WATER = 0.00 INCHES PORT SETTINGS: TEMP - 79.0 DEG F SYSTEM STATUS, REPORT 001 °1M BOARD 1 (RS -232) BAUD RATE 9600 ALL FUNCTIONS NORMAL PARITY ODD STOP BIT 1 STOP INVENTORY REPORT DATA LENGTH: 7 DATA T 1:DIE2EL AUTO TRANSMIT SETTINGS: VOLUME 412 GALS ULLAGE 136 GALS AUTO LEAK ALARM LIMIT 90e ULLAGE - B1 GALS DISABLED TO VOLUME = 408 GALS AUTO HIGH WATER LIMIT HEIGHT - 33.26 INCHES DISABLED WATER VOL = 0 GALS AUTO OVERFILL LIMIT WATER = 0.00 INCHES DISABLED TEMP - 79.0 DEG F AUTO LOW PRODUCT DISABLED AUTO LIMITSYSTEMSETUP DISABLEDFT OCT 26. 201! 10:06 -- _ AUTO DELIVERY START DISABLED AUTO DELIVERY END DISABLED AUTO EXTERNAL INPUT ON SYSTEM UNITS DISABLED U. . US AUTO EXTERNAL INPUT OFF S LANGUAGE DISABLED ENGLISHE AUTO SENSOR FUEL ALARM SYSTEM DATE /TIME FORMAT DISABLEDMONDDYYYYHH:MM:SS XM AUTO SENSOR WATER ALARM DISABLED SPRINTIVTPR AUTO SENSOR OUT ALARMSUMMERSTREETDISABLED BAKERSFIELD, CA 661 -332 -8592 SHIFT TIME I DISABLED SHIFT TIME 2 DISABLED SHIFT TIME 3 DISABLED RS -232 SECURITY SHIFT TIME 4 DISABLED CODE : 000000 TANK PERIODIC WARNINGS DISABLED TANK ANNUAL WARNINGS DISABLED LINE PERIODIC WARNINGS RS -232 END OF MESSAGE DISABLED DISABLEDLINEANNUALWARNINGS DISABLED PRINT TO VOLUMES ENABLED TEMP COMPENSATION VALUE (DEG F ): 60.0 STICK HEIGHT OFFSET DISABLED H--PROTOCOL DATA .FORMAT HEIGHT DAYLIGHT SAVING TIME ENABLED START DATE APR WEEK I SUN START TIME 2:00 AM END DATE OCT WEEK 4 SUN END TIME 2:00 AIM RE- DIRECT LOCAL PRINTOUT DISABLED SYSTEM SECURITY CODE : 000000 I N -TANI' SETUP T I:DIESEL PRODUCT CODE I THERMAL COEFF :.000450 TANK DIAMETER 48.00 TANK PROFILE 4 PTS FULL VOL 548 36.0 INCH VOL 448 24.0 INCH VOL 274 12.0 INCH VOL 100 FLOAT SIZE: 4.0 IN. 8496 WATER WARNING 110 HIGH WATER LIMIT: 2.0 MAX OR LABEL VOL: 548 OVERFILL LIMIT 90yo 493 HIGH PRODUCT 91% 496 DELIVERY LIMIT 50% 274 LOW PRODUCT 50 LEAK ALARM LIMIT: 25 SUDDEN LOSS LIMIT: 99 TANS: TILT 0.00 MANIFOLDED TANKS T #: NONE LEAK MIN PERIODIC: 25% 137 LEAK MIN ANNUAL 25% 137 PERIODIC TEST TYPE STANDARD ANNUAL TEST FAIL ALARM DISABLED PERIODIC TEST FAIL ALARM DISABLED GROSS TEST FAIL ALARM DISABLED ANN TEST AVERAGING: OFF PER TEST AVERAGING: OFF TANK TEST NOTIFY: OFF TNK TST SIPHON BREAK:OFF DELIVERY DELAY . 1 MIN LEAK TEST METHOD. SOFTWARE REVISION LEVEL VERSION 17.01 TEST DAILY TANK l SOFTWARE# 346017 -100 -B CREATED - 98.12.04.11.35 START TIME : 12:00 AM TEST RATE :0.20 GAL /HR S- MODULE# 330160 -100 -a DURATION 2 HOURS SYSTEM FEATURES: PERIODIC IN -TANY. TESTS ALARM HISTORY REPORT ANNUAL IN -TANK TESTS BIR SENSOR ALARM - - - -- LEAK TEST REPORT FORMAT L ]:DIESEL SUMP NORMAL PIPING BUMP FUEL ALARM OCT 26. 2011 8:08 AM FUEL ALARM DEC 6, 2010 10:03 AM FUEL ALARM OCT 6, 2009 9:59 AM ALARM HISTORY REPORT SYSTEM ALARM - - - -- LIQUID SENSOR SETUP PAPER OUT JUN 7, 2011 2:00 Ali PRINTER ERROR L I:DIESEL SUMP JUN 7, 2011 2:00 AM TRI -STATE (SINGLE FLOAT) BATTERY IS OFF CATEGORY : PIPING SUMP JAN 1, 1996 8:00 AM SOFTWARE MODULE WARP! JAN 1, 1996 8:OO AM x END * x x x L 2:DIESEL AN14ULAR TRI -STATE (SINGLE FLOAT) CATEGORY : ANNULAR SPACE ALARM HISTORY REPORT IN -TANK ALARM - - - -- T 1 :DIESEL OVERFILL ALARM ALARM HISTORY REPORT DEC 6. 2010 10:12 AM OCT 6, 2009 10:09 AM SENSOR ALARM - - - -- OCT 3, 2008 10:06 Ali L 2 :DIESEL ANNULAR ANNULAR SPACE EXTERNAL INPUT SETUP LOW PRODUCT ALARM FUEL ALARM OCT 17, 2005 12:52 PM OCT 26, 2011 9:35 AM NONE HIGH PRODUCT ALARM FUEL ALARMJUN15, 2007 6:47 AM OCT 26, 2011 8:O6 All INVALID FUEL LEVEL FUEL ALARM OCT 3. 2008 10 :08 AN OCT 26, 2011 8:05 AM OCT 17, 2005 12:52 PN1 PROBE OUT DEC 6, 2010 11:02 Ali DEC 6, 2010 10:08 AM OCT 6, 2009 11 :07 AM OUTPUT RELAY SETUP DELIVERY 14EEDED R I:ALARM DEC 6, 2010 10:08 Ali TYPE: APR 11, 2010 2:19 PM STANDARD OCT 6, 2009 11:07 AM NORMALLY OPEN IN -TANK ALARMS T ]:LEAK ALARM T ]:HIGH WATER ALARM T ]:OVERFILL ALARM T 1:BUDDEN LOSS ALARM T ]:HIGH PRODUCT ALARM T I:PROBE OUT T I:GROSS TEST FAIL LIQUID SENSOR ALMS L ]:FUEL ALARM L 2:FUEL ALARM L ]:HIGH LIQUID ALARM LOW TEMP WARNING NOV 30, 2007 8:45 AM X x X k END x* X X X UNDERGROUND STORAGE TANKS SECONDARY SYSTEM PINS CERTIFICATION FORM wRfM' f 25 BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 4 FACILITY ADDRESS FACILITY to DATE 715 Smywr - -o3 io 10 UST ANNULAR SPACE TANK 1 TANK 2 TANK 3 START TIME JD,•Z' qoi 25 BAKERSFIELD FIRE DEPARTMENT Prevention Services 2101 H Street Bakersfield, CA 93301 Phone: 661-326-3979 • Fax: 661-852-2171 Page 1 of 4 FACILITY ADDRESS FACILITY to DATE 715 Smywr - -o3 io 10 UST ANNULAR SPACE TANK 1 TANK 2 TANK 3 TANK 4 START TIME JD,•Z' qoi INITIAL PRESSURE 0"n Ili END TIME Ilf 25 'u" i/ ; S • *, FINAL PRESSURE 0;,, CERTIFICATION (Signature) r V-0- SECONDARY PIPING 4LIN 1 I E 2 LINE 3 LINE 4 START TIME INITIAL PRESSURE END TIME I/; XS ``" i/ ; S • *, FINAL PRESSURE CERTIFICATION (Signature) FD 2098 (Rev OWN) FACILITY ADDRESS jIfACILITY A 715 C &ioi n er- S}, rgakKs •Ale 1t/ 93 Fo/s LITY ID 01Y7, D /.2b ol i Al2 1E FA D Y Cl A rill ftOE SUMPS SUMP 1 SUMP 2 SUMP 3 SUMP 4 START TIME J0,f3/ /p; it INITIAL HEIGHT, OF WATER 1 aqa/, 69% TIME WATER HEIGHT TIME WATER HEIGHT TIME WATER HEIGHT CERTIFICATION (Signature) OVERFILL BUCKETS OVERFILL 1 OVERFILL 2 OVERFILL 3 OVERFILL 4 START TIME O Lip INITIAL HEIGHT OF WATER TIME WATER HEIGHT TIME WATER HEIGHT CERTIFICATION (Signature) Page 2 of 4 FD 2098 (Rev 08!07) FAC SPRINT BAKERSFIELD 715 E. SUMNER BAKERSFIELD CA. 93385 JAUREGUI AND CULUER INC_.. 1.0/26/2011 10:47 AM SUMP LEAK TEST REPORT DSL FIL TEST STARTED 10:31 AM TEST STARTED 10/26/2011 BEGIN LEVEL 1.6992 IN END TIME 10:46 AM f END DATE 16/26/2011 i END LEVEL 1.6987 [N LEAK THRESHOLD 0.662 IN TEST RESULT PASSED SPRINT BAKERSFIELD 715 E. SUMNER BAKERSFIELD CA. 93385 JAUREGUI AND CULUER. INC. 10/26/2011 11:02 k-1 SUMP LEAK TEST REPORT DSL FIL TEST STARTED 10:47 Am TEST STARTED 10/26/2011 BEGIN LEVEL 1.6987 IN END TIME 11:02 Rl END DATE 10/26/2011 END LEVEL 1.6986 IN LEAK THRESHOLD 0.002 IN TEST RESULT PASSEII